主视眼和非主视眼与年龄相关性白内障发病的关系

发布时间：2018-11-04 17:07

【摘要】：目的：探讨主视眼和非主视眼与年龄相关性白内障发病的关系,为年龄相关性白内障发病机制的研究及治疗提供新的思路和理论依据。方法：选取双眼病变程度相近的皮质性年龄相关性白内障(Age-related cataract, ARC)患者30例共60只眼,双眼视力相差不超过两行视标；年龄53-84岁,平均69.2±8.9岁。行双眼超声乳化加后房型人工晶体植入术。分别于术前及术后一周确定主视眼和非主视眼的眼别；术前分别测量主视眼和非主视眼在自然状态下和缩瞳后的晶体厚度；取术中撕取的中央部晶体前囊膜做HE染色,进行晶体囊膜上皮细胞(Lens epithelial cells, LEC)计数；并通过透射电镜观察主视眼和非主视眼LEC超微结构的变化。正常对照组为用于角膜移植的健康供体眼球晶体囊膜共4例,年龄28～40岁,平均34岁,HE染色后进行LEC计数。结果：病例组30例患者平均视力：主视眼组0.34±0.11,非主视眼组0.35±0.12,手术前后未出现主视眼转换情况；主视眼组和非主视眼组在自然状态下和缩瞳后的晶体厚度变化差值有显著统计学意义(P0.01)；主视眼组和非主视眼组的LEC密度分别为(3606±429)个/mm2和(3913±433)个/mm2,其差别有显著统计学意义(P0.01)。正常对照组的LEC平均密度为(4735±108)个/mm2,与病例组比较差别有显著统计学意义(P0.01)；透射电镜观察主视眼的LEC密度较非主视眼降低,上皮细胞大小形态不一,异常细胞表现为细胞间隙增大,甚至呈空泡样改变,细胞核多呈圆形,部分细胞的细胞器肿胀,胞膜溶解；部分细胞皱缩,染色质固缩周边化,呈早期凋亡改变。结论：在视觉活动中,主视眼的晶体厚度变化明显大于非主视眼；主视眼的LEC平均密度小于非主视眼；ARC患者的LEC密度明显小于正常对照组。ARC较多先发生于主视眼,推测原因为其在日常视觉活动中动用的调节度大,进入眼内的光线量大,引起眼内微环境的变化,造成了LEC的损伤,导致细胞密度的减少,从而导致白内障的发生。
[Abstract]:Objective: to explore the relationship between primary and undominant eyes and age-related cataract, and to provide new ideas and theoretical basis for the study and treatment of age-related cataract. Methods: 60 eyes of 30 Age-related cataract, ARC) patients with cortical age-related cataract with similar degree of binocular lesion were selected. The visual acuity difference between the two eyes was not more than two lines, the age was 53-84 years (mean 69.2 卤8.9 years). Bilateral phacoemulsification and posterior chamber intraocular lens implantation were performed. Before and one week after operation, the main eye and the non-main eye were determined, and the lens thickness of the primary eye and the non-primary eye were measured in the natural state and after pupil constriction, respectively. The anterior capsular membrane of the central lens was stained with HE to count the (Lens epithelial cells, LEC) of the epithelial cells and the ultrastructure of LEC in the primary and non-primary eyes was observed by transmission electron microscope. The normal control group consisted of 4 cases of normal donor lens capsule for corneal transplantation, aged 2840 years (mean 34 years). LEC was counted after HE staining. Results: the average visual acuity of 30 patients in the case group was 0.34 卤0.11 in the primary eye group and 0.35 卤0.12 in the non-main visual eye group. The difference of lens thickness between the primary eye group and the non-primary eye group was statistically significant (P0.01). The density of LEC was (3606 卤429) / mm2 and (3913 卤433) / mm2, in the primary eye group and the non-main eye group respectively. There was significant difference between the two groups (P0.01). The average density of LEC in the normal control group was (4735 卤10 8) / mm2, which was significantly different from that in the case group (P0.01). The LEC density of the primary eye was lower than that of the non-primary eye, and the size of epithelial cells was different. The abnormal cells showed enlarged intercellular space, even vacuolar changes, round nuclei and swelling of some cell organelles. Membrane dissolution; Some cells crumpled, chromatin pyknosis surrounding, early apoptotic changes. Conclusion: the change of lens thickness in the primary eye is obviously larger than that in the non-main eye, and the average density of LEC in the main eye is smaller than that in the non-main eye. The density of LEC in ARC patients was significantly lower than that in the normal control group. ARC occurred in the primary eye first, presumably because of its large regulation in daily visual activities and the large amount of light entering into the eye, which resulted in the change of the microenvironment in the eye. It causes damage to LEC, reduces cell density, and leads to cataract.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R776.1

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